Dealing with insurance companies can often be an overwhelming and frustrating process. Planning ahead of time can ensure you get the full benefits you deserve with a minimum delay. Key areas to consider include:
1. Pre-Approval
Some plans require pre-approval. This can be done by calling your insurance company and asking if they cover crutch alternatives. They will most likely ask for the H.C.P.C.S. (pronounced "Hics Pics") code. The generic code of a crutch alternative is "E0118". They may also ask for the diagnosis code or the procedure code. You can get this from your health care provider as it is specific to your condition.
If your insurance does cover the device, make sure to ask what percentage is covered and if you are required to get it from an in-network provider?
2. Other Options
Like all rules there are exceptions, so make sure you find out about the following:
- If none of the in-network providers carry the crutch alternative you need, you might be able to request an exception from your insurance company to allow you to go out of network.
- If you have a Flex Spending Account, crutch alternatives DO qualify as a medical expense. Some Flex accounts issue a Visa/MasterCard debit card that can be used.
- If you itemize your deductions on your taxes, you may be able deduct the rental/purchase of your crutch alternative as a medical expense (consult your tax professional for advice).
- If a crutch alternative allows you to return to work, your employer may pay for the rental/purchase.
- If you are willing to pay out-of-pocket for a crutch alternative because you can not imagine another day on crutches, the expense is often worth the freedom and mobility you will gain. Especially if you can heal faster because you are compliant with doctor's orders or because you can continue working.
3. Claims
Complete the insurance form which can usually be found online or sent to you by your insurer. Be sure to include a copy of:
1. Paid receipt
2. Your prescription
3. a completed Letter of Medical Necessity signed by your Physician
This may seem redundant, but if both are not submitted, your claim may be immediately denied. If you are renting, you may want to wait until you have returned your product and the final charges have been made. This way you will only have to submit one time. Make copies of everything you submit to your insurance company, just in case you need to re-submit!
4. Follow-up
To ensure nothing gets delayed, you may want to follow-up with a phone call to confirm that your claim was received and there is nothing more needed.
5. Appeals
If your insurance company denies the claim, you have the right to appeal. You can re-submit your claim and/or have your HR contact at work call the insurance company on your behalf. Any notes or documentation may be very helpful at this point. At every stage, document who you talked with, when you talked, and about what. It is much easier and affective to appeal with facts.
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Post Date : Feb 01, 2012 08:18:09
